Cardiac In class Flashcards
why would you also check BUN, urinalysis, serum creatitine, for the pt with HTN?
check for kidney damage
DASH eating plan
dietary approaches to stop hypertension
-fish, fruits and veggi, fiber, water
medication therapy for HTN
diuretics, beta adrenergic blockers, alpha adrenergic blockers, calcium channel blockers, ACE inhibitors, angiotensin 2 receptor blockers
hypertensive crisis
stystolic BP > 180 or diastolic BP > 120
IV Antihypertensive med therapy
rapid onset
med might be nitropress
-asses BP and HR every 2-3 minutes
-medication titrated to Mean Arterial Pressure
-we need a MAP greater than 60 to perfuse our organs
what to monitor in hypertensive crisis
EKG, for dysrhythmias, measure urine output to assess renal perfusion, neurological function,
patients with diabetes and angina relationship
they might not sense the angina, we can see a “silent ischemia” b/c of diabetic neuropathy
they are also at higher risk for atherosclerosis
women presentation of MI
atypical presentation of indigestion, shoulder pain, aching jaw, choking sensations, panic/anxiety , nausea and vomiting, diaphoresis
why/how would you use a pharmacological stress test
for people that cant handle exercise, you can give Adenoside to stress their heart
stable angina goals of treatment
reduce oxygen demand
-slowing heart rate
-reduce the force of contraction
-reduce the preload ( vasodilation Nitrate)
-reduce the afterload
if you give someone nitro… what do you need to check?
is their BP above 90?
have they had any sildenafil?
also tell them that they are going to get a headache
what happens during a myocardial infarction
stoppage of blood flow
-electrolyte imbalances
-oxygen stores used up
-glycogen stores are used up
-loss of potassium, calcium, and magnesium from the cells
-ischemia leads to the release of catecholamines
STEMI vs NON STEMI
Non-STEMI:
-partial thickness heart muscle damage
-ST segment depression, T wave inversion
-non occlusive thrombus
STEMI:
-complete occlusive thrombus
-full thickness heart muscle damage
-elevation of the ST segment
what is the primary biomarker used for diagnosis of MI
troponins
STEMI treatment
take them into the cathlab
and do a PCI
(if no PCI option, then thrombolytic)
“door to balloon is 90 min”
will an MI be relieved by rest or nitrate admin?
no
what are common insertion sites for cardiac catheterization
radial artery (wrist), and femoral artery (traditional site)
acute coronary syndrome interprofessional care
-upright positions
-oxygen to keep oxygen sat levels at 93%
-iV access
-12 lead ECG
-nitroglycerin
-dual anti-platelet therapy (aspirin and clopidogrel)
-statin
-morphine for pain not controlled by nitrates
are used for thrombolycs used for?
stemi’s
(not used for Non-Stemi)
why give iv nitroglycerin to someone having an MI
vasodilation of the veins to decrease preload
why give morphine
vasodialter and analgesic
atorvastatin
stabelize the plaque
b-adrenergic blocker
decrease dysrthmias
why use stool softeners for ACS?
so they dont strain
a pt is admitted to the unit following cardiac arrest and successful cardipulmonary resuscitation. which order should the nurse question:
A) oxygen
B) morphine suflate 2mg IV every 10 min
C) tissue plasminogen activator
D) iv nitroglycerin
the plasminiogen activator
b/c they had CPR and might have broken ribs etc
indications for a CABG
failed medical management
-not a candidate for PCI
-presence of left main coronary artery or three vessel disease
requires sternotomy and cardiopulmonary bypass
complications of cardiopulmonary bypass
-bleeding and anemia from damage to RBCs and platelets
-fluid and electrolyte imbalances
-hypothermia as blood is cooled as it passes through the bypass machine
-infections
taking care of the pt after a CABG procedure
monitor for dysrhythmias, beta blockers may be given
-they will have a sternal incision site, and a incision site where they got the vessel
-monitor sensory and motor function of the hand if they used a radial artery
-they may need calcium channel blockers to reduce incidence of arterial spasms (verapamil or diltiazam)
pulmonary artery catheter for hemodynamic monitoring - blood pressure and pulse
-chest tube to relieve the pressure and relieve fluid
-(they will have lots of tubes)
-replace blood and lecetrolytes, maintain body temp,
-heparin or lovanox to prevent DVT
what is the mona protocol?
drugs you use for someone coming in with heart attack
morphine
oxygen
nitrates
aspirin (and clopidogrel)
what care should be provided post PCI post STEMI
-lay them flat
-put weight/pressure on the incision site
-heparin, nitrates, morphine, beta blockers, ACE, CCB, statin, oxygen
what is the most common complication of an Myocardial infarction?
dysrhythmias - present in 80-90% of MI patients
v-fib or a-fib
-if a patient survives cardiac arrest, initiate a therapeutic hypothermia protocol as soon as possible
left sided HF symptoms
fluid back ups to the lungs, crackles, coughing up sputum, pulmonary edema,
right sided HF symptoms
JVD, hepatomegaly, edema in angkles
what do ANP and BNP do?
ANP produced by the atria
BNP produced by the ventricles
they lead to water reabsorption (and are released when there is too much volume)
but they aren’t nearly as strong as the renin-angiotensin system
-they are a marker of how much stretch is happening
(above 900 would indicate severe heart failure )
would cardiac enzymes be elevated in heart failure?
no, but they could rule out an MI
dilated
systolic HF
hypertrophy
diastolic HF
digoxin and furosemide what to worry about
hypokalemia leading to dig tox
range for ABI
ankle-brachial index normal is 0.91-1.30
venous stasis ulcers
big and moist
arterial disease ulcers
small round dry on top of bone
assessment comparison between venous and arterial disease
arterial: temp is cool, pain is worse with elevation, claudication, decreased or weak pulses
venous: edema, pain is relieved by elevation, temp of extremity is warm and moist
